Apparatus for and method of providing a hip replacement

ABSTRACT

A short main incision and portal incisions at portal positions strategically displaced from the main incision are provided in a patient&#39;s hip. One portal incision (acetabular portal) provides for a disposition of reamers in the patient&#39;s acetabulum to shape the acetabulum. A cannula is inserted through the portal incision to the acetabulum and the successive reamers of progressive size are inserted into the acetabulum through the main incision to progressively size and shape the acetabulum. An approximately hemispherical acetabular component is then disposed in the prepared acetabulum to provide for hip rotation relative to the femoral component. The other portal incision (femoral portal) provides for insertion into the patient&#39;s hip of a member for driving the femoral stem into a cavity in the patient&#39;s femur. The provision of the short main incision and the portal incision minimizes the patient&#39;s loss of blood, tissue trauma, length of operating time and patient recovery time.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of and claims priority to:application Ser. No. 12/941,256, filed Nov. 8, 2010, which is acontinuation of application Ser. No. 11/332,051, filed Jan. 13, 2006,which is issued as U.S. Pat. No. 7,833,229, which is a continuation ofapplication Ser. No. 10/932,742, filed Sep. 1, 2004, which is issued asU.S. Pat. No. 6,997,928; application Ser. No. 10/683,008, filed Oct. 9,2003, which is issued as U.S. Pat. No. 6,905,502; and application Ser.No. 10/166,209, filed Jun. 10, 2002 (the parent of application Ser. No.10/683,008), which is abandoned, the entire disclosures of which areincorporated herein by reference.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not applicable

REFERENCE TO A MICROFICHE APPENDIX

Not applicable

FIELD OF THE INVENTION

This invention relates to a method of providing a replacement for apatient's hip with a minimal loss of blood, minimal tissue trauma and aminimal length of operating time and patient recovery time. Theinvention also relates to a tool which is needed in the methodconstituting this invention.

BACKGROUND OF A PREFERRED EMBODIMENT OF THE INVENTION

Great progress has been made in the field of hip replacements.Considering that hip replacements may not even have existed a generationago, hip replacements, particularly among the elderly, are nowrelatively common. In spite of the considerable progress which has beenmade, hip replacement operations are still relatively crude. Forexample, an incision of a relatively great length still has to be madein a patient's hip as one of the first steps in a hip replacementoperation. The incision may be as long as approximately eight inches(8″) to approximately twelve inches (12″).

Such a large incision has caused patients to lose large amounts of bloodand to suffer significant trauma. It has caused the length of theoperation and the patient recovery time to be relatively long.

BRIEF DESCRIPTION OF A PREFERRED EMBODIMENT OF THE INVENTION

A minimal length main incision (e.g., approximately 1½″-3″ long) and twoportal incisions (each significantly less than 1″ long) strategicallydisplaced from the main incisions are provided in a patient's hip. Acannula is inserted through the portal incision to the acetabulum and ashaft is inserted through the cannula. A reamer is disposed through themain incision in the acetabulum and coupled to the shaft to ream theacetabulum when the shaft is rotated. Reamers of progressive size arethen coupled to the shaft to progressively shape and size a socket inthe acetabulum. An approximately hemispherical acetabular component isthen disposed in the acetabulum to provide for hip rotation relative tothe femur. The other portal (femoral portal) incision provides for apreparation of an insertion of a member into the patient's hip forpreparing a femoral canal and then driving the' femoral stem into acavity in the patient's femur.

The provision of the main incision and the portal incision.s minimizesthe patient's loss of blood, tissue trauma, length of operating time andpatient recovery time.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings:

FIG. 1 is a fragmentary schematic side elevational view of a patient'ship and shows a main incision and portal incisions made in the patient'ship as an initial step in providing for a replacement of the patient'ship;

FIG. 2 is a side elevational view of a tool used by a surgeon todetermine the positioning of the portal incisions in the patient's hipafter the formation of the main incision in the patient's hip;

FIG. 3 is an enlarged fragmentary sectional view of a patient's hip andshows the formation of the main incision in the patient's hip;

FIG. 4 is an enlarged fragmentary sectional view similar to that shownin FIG. 3 and shows the approximate positioning of the main incision inrelation to a hip bone and a femur in the patient;

FIG. 5 is an enlarged fragmentary sectional view similar to that shownin FIG. 4 and shows the positioning of the tool of FIG. 2 in thepatient's hip to determine the position of the portal incision forproviding an acetabular shaping of the hip bone;

FIG. 6 is an enlarged fragmentary sectional view similar to that shownin FIG. 5 and shows partial insertion of a cannula into the patient'ship through the portal incision to provide for an acetabular shaping inthe patient's hip;

FIG. 7 is a fragmentary sectional view similar to that shown in FIGS. 5and 6 and shows the positioning of a reamer through the cannula and theoperation of the reamer to form the acetabulum in the patient's hipbone;

FIG. 8 is an enlarged fragmentary sectional view similar to that shownin FIGS. 5-8 and schematically shows the use of reamers of progressivelyincreased size to shape the acetabulum in the patient's hip;

FIG. 9 is an enlarged fragmentary sectional view of one of the reamersshown in FIGS. 5-8;

FIG. 10 is an enlarged fragmentary sectional view similar to that shownin FIG. 7 and shows a reamer which is large in comparison to the reamershown in FIG. 7;

FIG. 11 is a fragmentary sectional view similar to that shown in FIGS. 5and 6 and shows the insertion of an approximately hemisphericalacetabular component into the acetabulum of the patient's hip to providethe pivotable relationship between the femoral ball and the acetabulumin the patient's hip bone;

FIG. 12 is an enlarged fragmentary sectional view similar to that shownin FIG. 4 and shows the positioning relative to a femoral stem of a toolsimilar to that shown in FIG. 2 to determine the positioning of theportal for the femoral incision for obtaining the disposition of afemoral stem in a cavity in the patient's femur;

FIG. 13 is an enlarged fragmentary sectional view similar to that shownin FIG. 12 and shows the positioning of a cannula through the portalincision and the positioning of a rasp through the cannula to providefor the smoothing of the walls of the femur cavity;

FIG. 14 is an enlarged fragmentary sectional view similar to that shownin FIG. 13 and shows how the femoral stem becomes disposed in the femurcavity; and

FIG. 15 is an enlarged fragmentary sectional view similar to that shownin FIGS. 13 and 14 and shows the proper disposition of the femoral stemin the femur cavity.

DETAILED DESCRIPTION OF A PREFERRED EMBODIMENT OF THE INVENTION

In the following detailed description of the preferred embodiments,reference is made to the accompanying drawings which form a part hereof,and in which are shown by way of illustration specific embodiments inwhich the invention may be practiced. It is to be understood that otherembodiments may be utilized and structural changes may be made withoutdeparting from the scope of the present invention.

FIGS. 1-15 show progressive steps in performing a method constituting apreferred embodiment of the invention and also show apparatus includedin the patentable features of the preferred embodiment of thisinvention. FIG. 1 schematically shows a patient's hip 10 and also showsa main incision 12 and a pair of portal incisions 14 and 16 may be anacetabular portal incision, may be on one side of the main incision andmay be significantly less than one half inch (½″) in length. Asindicated in FIGS. 5-8 and 10-11, and as will be appreciated by those ofskill in the art, the position of the acetabular portal incision 16 isselected to provide access to the acetabulum 22 in cooperation with themain incision 12 but without providing access to the patient'sacetabulum 22 through the patient's femoral neck. The incision 14 may bea femoral incision, may be on the other side of the main incision 12from the acetabular incision 16 and may also be significantly less thanone half inch (½″) in length. The portal incisions 14 and 16 may be ofthe same approximate length.

A tool generally indicated at 18 is shown in FIG. 2. The tool 18 mayillustratively be used to locate the position of the portal incision 16.The tool 18 includes a positioning member 20 which may preferably have ahemispherical configuration to fit in an acetabulum 22 (FIG. 4) when theposition of the acetabular portal incision 16 is being determined. Alooped extension portion 24 extends from the positioning member 20. Theportion 24 is preferably looped to extend through the main incision 12to a position external to the patient's hip 10 and then to extend to aposition approximating the position of the acetabular portal incision16. It will be appreciated that the looped portion 24 may have adifferent configuration than that shown in FIG. 2 provided that theright end in FIG. 2 has a position corresponding substantially to thatshown in FIG. 2. A marker member 26 such as a stylus attached to thelooped portion at the right end of the looped portion 24 in FIG. 2. Themarker member 26 is retained by a holder 28. As will be seen, the holder28 and the marker member 26 have a substantially identical axialrelationship with the positioning member 20.

A first step in the performance of applicant's method is shown in FIG.3. In this step, a cutter 30 is used to provide the main incision 12.This incision is preferably made anterior to, directly over or posteriorto the greater trochanter. It will accordingly be appreciated that thepositioning of the main incision 12 is somewhat discretionary. FIG. 4 isa somewhat schematic view showing the approximate positioning of themain incision 12 relative to the positioning of the patient's hip bone32 and femur 34.

FIG. 5 shows the hip bone 32 and the acetabulum 22 in the hip bone. FIG.5 shows the disposition of the tool 18 with the positioning member 20 inthe acetabulum 22. In this disposition, the marker member 26 abuts thepatient's skin 36 in the region of the patient's hip and causes a mark38 to be produced on the patient's skin. This mark indicates theposition to be provided for the acetabular portal incision 16. FIG. 6illustrates the positioning of a cannula 40 so that extends through theacetabular incision 16 at the mark 38 in the direction toward the axisof the positioning member 20. As indicated in FIGS. 5-8 and 10-11, andas will be appreciated by those of skill in the art, the cannula 40communicates between the acetabular portal incision 16 and theacetabulum 22 without passing through the patient's femoral neck.

FIG. 7 shows a shaft 42 extending through the cannula 40 and coupled toa reamer 44 which is disposed in the acetabulum 22. A motor 46 drivesthe shaft in one rotary direction to operate the reamer 44. The rotarymovement of the shaft 42 is indicated at 48. As will be appreciated, theacetabulum 22 is sequentially reamed by reamers 44 of progressivelyincreasing size. This is illustrated at 44 a in FIG. 7 and at 44 a and44 b in FIG. 8. It may also be seen by comparing the size of the reamers44 a and 44 b respectively in FIGS. 7 and 10 and also in FIG. 8. Whenthe acetabulum 22 has the desired shape, size and smoothness, ahemispherical shell (acetabular component or a trial component) 45 (FIG.11) is introduced into the acetabulum 22 to provide a pivotalrelationship with the femoral head. This may be accomplished by applyinga mallet 50 to the shaft extending thru the cannula 40 as illustratedschematically at 50 in FIG. 11.

FIGS. 12-15 relate to the formation of the femoral portal incision 14and the use of this incision in connection with the disposition of thefemoral stem 52 in a cavity 54 (FIG. 15) in the femur 34. As shown inFIG. 12, a tool generally indicated at 56 is provided to determine theposition of the femoral portal incision 14. The tool 56 is similar in anumber of respects to the tool 18. For example, the tool 56 may includean extension portion 58 and a marker member 60 respectivelycorresponding in configuration to the extension portion 24 and themarker member 26 in FIG. 2. The dimensions of the extension portion 58may be different from those of the extension portion 24. The tool 56 mayalso be provided with a drive member 62 at the end opposite the markermember 60. The drive member 62 may have a finger configuration. Themarker member 60 and the drive member 62 preferably are disposed on thesame axis. When the drive member 62 is inserted into the main incision12 and is disposed against the femoral stem 52, the marker member 60makes a mark 63 a long scalpel blade may be passed thru this portallocator sleeve to indicate the position of the femoral portal incision14 as shown in FIG. 12. A relatively long scalpel blade may then bepassed through this portal locator sleeve.

A cannula 64 (FIG. 13) is then inserted through the femoral portalincision 14 to a position adjacent the femoral stem 32. If soft tissuespermit, a cannula need not always be used. A rasp 66 or, a reamer, adrill or a tamp is passed through the cannula 64 into the cavity 54 inthe femur 34 and is operated to prepare the walls of the cavity toreceive the femur. In the claims, the term “rasp” is intended to includea reamer, drill or tamp or other suitable component. The rasp 66, or, areamer, a drill or a tamp is then withdrawn from the cannula 64 and adrive member 68 (FIG. 14) is inserted through the cannula to abut thefemoral stem. This is shown in FIG. 14. A mallet 70 in FIG. 15 is thenapplied against the drive member 68 to move the femoral stem 52 into thecavity 54 in the femur 34. This is shown in FIG. 15.

Although the present invention has been described in terms of specificembodiments, it is anticipated that alterations and modificationsthereof will no doubt become apparent to those skilled in the art. It istherefore intended that the following claims be interpreted as coveringall alterations and modifications that fall within the true spirit andscope of the invention.

What is claimed is:
 1. A surgical method, comprising: inserting apositioning member of a first tool into a first incision, the first toolincluding an extension portion that extends from the positioning memberat a first end to a holder at a second end; using the holder to mark alocation for a second incision while the positioning member is disposedwithin an acetabulum; making the second incision based on the locationidentified by the holder; and inserting a cannula through the holder andinto the second incision.
 2. The surgical method of claim 1, wherein alength of the first incision is greater than a length of the secondincision, and wherein a length of the second incision is less than about½ inch.
 3. The surgical method of claim 1, further comprising: feeding arotatable shaft through the cannula; coupling a first reamer to aterminal end of the rotatable shaft, the first reamer being insertedthrough the first incision; and reaming the acetabulum using the firstreamer.
 4. The surgical method of claim 3, further comprising: insertinga second reamer into the first incision, wherein the second reamer islarger in size than the first reamer; and coupling the second reamer tothe terminal end of the rotatable shaft.
 5. The surgical method of claim3, further comprising introducing an acetabulum component into thereamed acetabulum.
 6. The surgical method of claim 1, furthercomprising: inserting a drive member of a second tool into the firstincision, the second tool having an extension portion that extends fromthe drive member disposed at a third end to a second cannula disposed ata fourth end; and inserting the second cannula through a third incisionwhile the drive member is disposed against a femoral stem.
 7. Thesurgical method of claim 6, further comprising: inserting a rasp throughthe second cannula and into the third incision; preparing a cavity in afemur to receive a femoral stem using the rasp; and inserting thefemoral stem into the cavity formed in the femur.
 8. The surgical methodof claim 7, wherein the rasp is one of a reamer, a drill, and a tamp. 9.The surgical method of claim 1, wherein the first incision is anteriorto, directly over, or posterior to a greater trochanter of a patient.10. A surgical method, comprising: making a first incision having afirst length directly over, anterior to, or posterior to a greatertrochanter of a patient; inserting a first end of a first tool into thefirst incision, the first tool extending from the first end to a secondend that includes a holder; inserting a first cannula through the holderand into a second incision while the first end of the tool is disposedadjacent to an acetabulum of the patient, wherein a length of the firstincision is greater than a length of the second incision, and wherein alength of the second incision is less than about ½ inch.
 11. Thesurgical method of claim 10, further comprising: inserting a rotatableshaft through the first cannula; coupling a reamer to a terminal end ofthe rotatable shaft; and reaming the acetabulum using the reamer. 12.The surgical method of claim 11, further comprising: inserting a secondreamer into the first incision, wherein the second reamer is larger insize that the first reamer; and coupling the second reamer to theterminal end of the rotatable shaft.
 13. The surgical method of claim11, further comprising introducing an acetabulum component into thereamed acetabulum through the first incision.
 14. The surgical method ofclaim 10, wherein the first tool includes a curved extension thatextends from the first end to the second end such that first end isaxially aligned with the second end.
 15. The surgical method of claim10, further comprising: inserting a first end of a second tool into thefirst incision, the second tool having a curved extension that extendsto a second end that includes a second cannula; and inserting the secondcannula through a third incision when the first end of the second toolis disposed against a femoral stem.
 16. The surgical method of claim 15,further comprising: inserting a rasp into the second cannula; preparinga cavity in a femur sized and configured to receive a femoral stem usingthe rasp; and inserting the femoral stem into the cavity formed in thefemur.
 17. A surgical method, comprising: inserting a first end of afirst tool into a first incision made in a hip of a patient, the firsttool including a curved portion that extends to a second end thatincludes a first holder that is axially aligned with the first end;inserting a first cannula through the holder and into a second incision;inserting a first end of a second tool into the first incision, thesecond tool including a curved portion that extends to a second end thatincludes a second holder that is axially aligned with the first end ofthe second tool; and inserting a second cannula through the secondholder and into a third incision wherein a length of the first incisionis greater than a length of the second incision, and wherein a length ofthe second incision is less than about ½ inch.
 18. The surgical methodof claim 17, further comprising: inserting a rotatable shaft through thefirst cannula; coupling a reamer to an end of the rotatable shaft; andreaming the acetabulum using the reamer.
 19. The surgical method ofclaim 17, further comprising introducing an acetabulum component into anacetabulum through the first incision.
 20. The surgical method of claim17, further comprising: inserting a rasp through the second cannula andinto the third incision; preparing a cavity in a femur sized andconfigured to receive a femoral stem using the rasp; and inserting thefemoral stem into the cavity formed in the femur.